NPI | 1255348603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 1565) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 828) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2011-11-30 |