| NPI | 1497097133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05839) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6966) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-12-20 |