| NPI | 1033515762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4177) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33138) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2023-10-27 |