| NPI | 1861597494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-4792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2005031331) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |