| NPI | 1922508332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5885) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 44619) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-07-31 |