| NPI | 1467480822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OK 1806) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OK 1806) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-01-11 |