| NPI | 1417040478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3458) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: OK 365) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-09 |