| NPI | 1225416324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105706) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05706) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2018-06-16 |