NPI | 1225476278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5718) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60496961) |
111N00000X Chiropractor (Licence: MN 5809) | |
Enumeration Date | 2013-06-12 |
Last Update Date | 2021-03-04 |