| NPI | 1184050676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR 7025) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2015-11-03 |