NPI | 1194724989 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AL 1059) |
Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AL 1059) |
Enumeration Date | 2005-07-14 |
Last Update Date | 2019-09-04 |