| NPI | 1043580608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4020) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: OK 4020) |
| 111NN1001X Chiropractor, Nutrition (Licence: OK 4020) | |
| 111NR0400X (Licence: OK 4020) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2024-04-14 |