| NPI | 1992767875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 929) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 1841) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2023-08-14 |