| NPI | 1659046530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0106032) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2020003793) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2026-01-01 |