| NPI | 1366434680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 1536) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1462) |
| 111N00000X Chiropractor (Licence: OK 3388) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2024-03-06 |