| NPI | 1194725283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 4665) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3546) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2011-11-28 |