| NPI | 1487738167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-03788) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 006116) |
| 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-03788) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO 006116) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-12-13 |