| NPI | 1124453196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: KS 01-04679) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-04679) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |