| NPI | 1063834398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05646) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013045571) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2025-09-22 |