| NPI | 1760620371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3918) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8185842-1202) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2015-12-28 |