NPI | 1407827082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555984) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S02175) |
111NS0005X Chiropractor, Sports Physician (Licence: MD S02175) | |
Enumeration Date | 2006-01-31 |
Last Update Date | 2014-10-09 |