NPI | 1265658249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5563) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 952947271202) |
Enumeration Date | 2007-04-18 |
Last Update Date | 2007-07-08 |