| NPI | 1801047733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1818) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: OR 1818) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2008-10-09 |