| NPI | 1184624793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-03589) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS C3589) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2020-10-05 |