| NPI | 1730580549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05695) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014032168) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2016-12-07 |