| NPI | 1912187006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05164) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS T-01655) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2016-01-21 |