| NPI | 1326026592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05278) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005068) |
| 111N00000X Chiropractor (Licence: IA 04864) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2012-12-06 |