| NPI | 1932347531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 05049) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 1905) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2009-02-04 |