| NPI | 1588001184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105548) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33677) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2021-06-17 |