| NPI | 1447275482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-04773) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2000166830) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-05-11 |