| NPI | 1700133170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0104956) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TX 13773) |
| 111NI0900X Chiropractor, Internist (Licence: OK 3922) | |
| Enumeration Date | 2012-08-05 |
| Last Update Date | 2024-07-08 |