| NPI | 1619920915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05027) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5623) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-02-16 |