| NPI | 1376794164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS T-02316) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05223) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2023-09-20 |