| NPI | 1184887465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05449) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2008008058) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2012-03-13 |