NPI | 1003217449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 9123542-1202) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9123542-1202) |
Enumeration Date | 2014-09-04 |
Last Update Date | 2020-10-01 |