NPI | 1376627059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0104895) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-04895) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2022-10-27 |