| NPI | 1962513077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 937) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 2102) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-01-12 |