| NPI | 1881773745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3908) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25338) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2010-04-23 |