| NPI | 1639421845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05584) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6911) |
| 111N00000X Chiropractor (Licence: MO 2014041844) | |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2018-09-26 |