| NPI | 1093104051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05680) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1828) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-04-02 |