| NPI | 1093931743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-4367) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2469) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-12-01 |