| NPI | 1639332042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 28153) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3359) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2016-03-08 |