NPI | 1255420139 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 273119) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OR 273119) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2012-12-17 |