NPI | 1215051255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-2922) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1143) |
Enumeration Date | 2007-03-16 |
Last Update Date | 2023-09-11 |