| NPI | 1063576023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 4897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 8111) |
| 111N00000X Chiropractor (Licence: MO 2004020267) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2016-07-21 |