| NPI | 1942230222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 089006218RN) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 27 2886) |
| 111N00000X Chiropractor (Licence: MA 1881) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2025-09-11 |