| NPI | 1588096051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01--5574) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013032679) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2021-06-22 |