NPI | 1386932275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR008841) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1951) |
Enumeration Date | 2011-07-13 |
Last Update Date | 2012-03-09 |