| NPI | 1831407063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 4042) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC153703) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2011-04-14 |