| NPI | 1952391088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 271776) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2009-09-25 |