NPI | 1417001868 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NI0900X Chiropractor Internist (Licence: CO CO4130) |
Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA CO4130) |
Enumeration Date | 2007-01-23 |
Last Update Date | 2007-07-08 |