| NPI | 1184955262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009032229) |
| 111N00000X Chiropractor (Licence: GA CHIR009134) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2016-09-08 |