| NPI | 1265443543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 2663) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: OK 304) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2009-03-09 |