NPI | 1104973601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: GA chiro09238) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001593) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2014-04-09 |