| NPI | 1144382482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK OK2205) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 2205) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2019-04-10 |