| NPI | 1922092873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 3407) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OK 489) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2010-12-02 |