NPI | 1548231012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556345) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 004337) |
111N00000X Chiropractor (Licence: FL CH12425) | |
Enumeration Date | 2006-01-31 |
Last Update Date | 2018-11-13 |