| NPI | 1629250972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007040) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS T-01679) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2008-07-31 |