| NPI | 1033414099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105414) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556862) |
| 111N00000X Chiropractor (Licence: MO 2011025065) | |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2024-04-30 |