NPI | 1013392505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4198) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05737) |
Enumeration Date | 2015-07-24 |
Last Update Date | 2018-03-13 |