| NPI | 1134585144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4396) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05763) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: KS 01-05763) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2021-01-27 |