| NPI | 1932367539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 04348) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 6478) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-09-10 |