| 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 | 2025-08-15 |