| NPI | 1790956555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 71 3762) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC160346) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2012-12-19 |