| NPI | 1801037411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11137) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2016-12-13 |