NPI | 1508263203 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9167751-1202) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2115) |
Enumeration Date | 2014-11-24 |
Last Update Date | 2023-09-29 |