NPI | 1073765137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6100) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2294) |
Enumeration Date | 2008-10-21 |
Last Update Date | 2020-10-08 |