| NPI | 1386744381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 04803) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: KS 04803) |
| 225100000X Physical Therapist (Licence: KS 04803) | |
| 225700000X Massage Therapist (Licence: KS 04803) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-10-05 |