| NPI | 1073559258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS C3717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-03717) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-06-17 |