| NPI | 1609214956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-05550) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05550) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-05-21 |