| NPI | 1396029773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05641) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6740) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2014-09-11 |