| NPI | 1740588714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4064) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11689) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2023-12-05 |