| NPI | 1063859650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05538) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2022-11-18 |