| NPI | 1023421179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: KS KS-01-05421) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: KS KS-01-05421) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2023-01-04 |