NPI | 1376529388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 980) |
Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: SD 980) |
Enumeration Date | 2005-12-21 |
Last Update Date | 2012-09-06 |