| NPI | 1699770743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3287) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6787) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-01-30 |