| NPI | 1992767248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 27-1590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 0564) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2009-07-08 |