| NPI | 1477218170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4453) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: OK 4453) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2021-11-15 |