| NPI | 1558378752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OK 3554) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: OK 3554) |
| 111NX0800X Chiropractor, Orthopedic (Licence: OK 3554) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |