| NPI | 1790727824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: OK 1769) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 1769) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-06-13 |