| NPI | 1952317760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 4092) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 1339715052RN) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54167CRNA) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2008-09-03 |