| NPI | 1346272028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: KS 01-04846) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: MO 2003032014) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2018-05-29 |