| 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 Chiropractor Rehabilitation (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 |