| NPI | 1144527995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05354) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010033747) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |