| NPI | 1558174821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4460) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 16387) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-01-29 |