NPI | 1386791820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: VA 0104556439) |
Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC009617) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2007-07-08 |