NPI | 1184885402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556670) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 769635237) |
Enumeration Date | 2008-06-19 |
Last Update Date | 2016-10-21 |