| NPI | 1639247687 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3741) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19944) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |