| NPI | 1083025670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4154) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: OK 4154) |
| 111NS0005X Chiropractor Sports Physician (Licence: OK 4154) | |
| 111NX0100X Chiropractor Occupational Health (Licence: OK 4154) | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2017-04-07 |