| NPI | 1619145026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105307) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7778) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2011-03-07 |