| NPI | 1952067712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 282581) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4412) |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2023-02-01 |