| NPI | 1568461408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: KS C3600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS C3600) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2009-05-12 |