| NPI | 1164480463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OK 2506) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: OK 2506) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-07-08 |