| NPI | 1033215108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05530) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8642) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-01-05 |