NPI | 1114928678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 005746) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00361400) |
111N00000X Chiropractor (Licence: PA DC-003921-L) | |
Enumeration Date | 2005-08-09 |
Last Update Date | 2012-10-10 |