| NPI | 1356443717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-4626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 176574) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2016-03-28 |