NPI | 1316093545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000941) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC4755L) |
111N00000X Chiropractor (Licence: NJ 38MC00413500) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2019-07-25 |