| NPI | 1851405575 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05130) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007004026) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2015-06-01 |