| NPI | 1720433444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0105790) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05790) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2019-02-04 |