| NPI | 1447934625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4621) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9307) |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2024-08-06 |