| NPI | 1295911287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5586) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OK 3864) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2018-03-17 |