| NPI | 1699105791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-06295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007060) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2024-06-04 |