| NPI | 1770853012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05422) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2011007953) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |