NPI | 1457403354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4436) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x0098261) |
111N00000X Chiropractor (Licence: PA DC007773L) | |
Enumeration Date | 2007-01-18 |
Last Update Date | 2015-01-01 |