| NPI | 1982735528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 272836) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00432) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2019-10-28 |