| NPI | 1124453089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05565) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: KS 01-05565) |
| 111NX0800X Chiropractor, Orthopedic (Licence: KS 01-05565) | |
| 111NN1001X Chiropractor, Nutrition (Licence: KS 01-05565) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-05565) | |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: KS 01-05565) | |
| 111NR0200X Chiropractor, Radiology (Licence: KS 01-05565) | |
| 111NR0400X (Licence: KS 01-05565) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2022-06-16 |