| NPI | 1013739721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-06350) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2024032590) |
| Enumeration Date | 2024-10-25 |
| Last Update Date | 2024-10-25 |