| NPI | 1396836235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105018) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005420) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |