| NPI | 1700254174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02952) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05743) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2025-08-20 |