| NPI | 1861558017 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05112) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2005032885) |
| 111N00000X Chiropractor (Licence: OK 3766) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2008-06-18 |