| NPI | 1952556037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3896) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OR 11637) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2009-01-22 |