| NPI | 1356710479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05748) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2016033334) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2022-12-15 |