| NPI | 1396801692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4127) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2916) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2021-04-14 |