| NPI | 1174637508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3243) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29750) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-02-03 |