| NPI | 1770853327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: KS 01-05411) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-05411) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-23 |