| NPI | 1932103751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-04961) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2005006923) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-04-20 |