| NPI | 1588842215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: KS 01-06098) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MO 2008010465) |
| 111NR0200X Chiropractor, Radiology (Licence: TX 13668) | |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2022-11-08 |