| NPI | 1245604305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05755) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2016005840) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2018-07-16 |