| NPI | 1821498320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4199) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12668) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2018-07-09 |