| NPI | 1609192483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4182) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007227) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2015-12-09 |