| NPI | 1164404083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 04431) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 104431) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-04-08 |