| NPI | 1629061858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-03482) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-03482) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-08-02 |