NPI | 1285042515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1676) |
Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: LA 1676) |
Enumeration Date | 2014-07-30 |
Last Update Date | 2018-10-29 |