| NPI | 1659574184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS t-01281) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2012-10-03 |