| NPI | 1922657154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4426) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 1041) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2023-09-18 |