| NPI | 1386645349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: KS 3953) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: OK 3111) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2017-01-24 |