| NPI | 1376980698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: KS 01-05542) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: KS 01-05542) |
| 111NR0400X (Licence: KS 01-05542) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-05542) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: KS 01-05542) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: KS 01-05542) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2013-08-01 |