| NPI | 1538103445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555745) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-07-09 |