NPI | 1235431701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 008745) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 010359) |
111NI0013X Chiropractor, Independent Medical Examiner (Licence: PA 010359) | |
111NI0013X Chiropractor, Independent Medical Examiner (Licence: GA CHIR008745) | |
Enumeration Date | 2010-12-03 |
Last Update Date | 2010-12-03 |