NPI | 1457508517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OH 4036) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008368) |
Enumeration Date | 2008-08-20 |
Last Update Date | 2015-08-21 |