| NPI | 1861128712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4558) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008554) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2024-02-09 |