NPI | 1164569703 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2025) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 16762) |
Enumeration Date | 2007-01-31 |
Last Update Date | 2012-06-15 |