| NPI | 1073949228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05576) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: KS 0105576) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2019-06-11 |