| NPI | 1902348485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: KS 01-05771) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: KS 01-05771) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-11-15 |