NPI | 1114223328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03727) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556982) |
111N00000X Chiropractor (Licence: NY 4444) | |
Enumeration Date | 2011-02-04 |
Last Update Date | 2019-09-05 |