| NPI | 1124758909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-06247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 2130) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-02-24 |