NPI | 1467419887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001141) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X08954) |
Enumeration Date | 2006-04-28 |
Last Update Date | 2017-08-17 |