| NPI | 1194712646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3999) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 4100) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2011-08-30 |