NPI | 1083670897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008980) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 009502) |
111N00000X Chiropractor (Licence: AZ 7990) | |
Enumeration Date | 2006-04-21 |
Last Update Date | 2012-08-30 |