| NPI | 1225533201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13717) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2018-03-29 |