| NPI | 1518605807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4612) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9199) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2024-06-11 |