NPI | 1528268612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1451) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6084) |
Enumeration Date | 2007-07-18 |
Last Update Date | 2023-03-09 |