| NPI | 1124622386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-06050) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2020013407) |
| 111NN1001X Chiropractor, Nutrition (Licence: KS 01-06050) | |
| 111NN1001X Chiropractor, Nutrition (Licence: MO 2020013407) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MO 2020013407) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: KS 01-06050) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: MO 2020013407) | |
| Enumeration Date | 2020-11-27 |
| Last Update Date | 2020-11-27 |