| NPI | 1205873346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3791) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30193) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-09-09 |