| NPI | 1235892498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-06154) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2021036199) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2023-11-09 |