| NPI | 1851496483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS C3757) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 4913) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-10-26 |