NPI | 1316942147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 684) |
Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: LA 684) |
111NR0400X (Licence: LA 684) | |
111NS0005X Chiropractor, Sports Physician (Licence: LA 684) | |
111NX0800X Chiropractor, Orthopedic (Licence: LA 684) | |
Enumeration Date | 2005-06-17 |
Last Update Date | 2022-10-11 |