NPI | 1497079396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 31605) |
Additional Taxonomies | 111NR0400X (Licence: CA 31605) |
Enumeration Date | 2010-03-21 |
Last Update Date | 2010-03-21 |