| NPI | 1912026196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3444) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273444) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2011-12-08 |