| NPI | 1871833962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS C-3649) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2022-10-06 |