| NPI | 1972785921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: OR 3773) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3773) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 3773) | |
| Enumeration Date | 2007-12-01 |
| Last Update Date | 2022-06-14 |