| NPI | 1912195157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-03884) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: KS 01-03884) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2007-12-12 |