| NPI | 1073849964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-5230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007012104) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2009-10-27 |