NPI | 1063738995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000790) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010264) |
111NR0400X (Licence: PA AJ010063) | |
Enumeration Date | 2010-04-16 |
Last Update Date | 2012-06-27 |