| NPI | 1215027255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 2393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4540) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2012-10-31 |