| NPI | 1689644544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 1596) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3175) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2010-07-23 |