| NPI | 1992856454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5413) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2009-07-28 |