NPI | 1477071686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10768566-1202) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2017031983) |
Enumeration Date | 2017-09-07 |
Last Update Date | 2021-02-05 |