NPI | 1548656127 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO chr.0008081) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WA ch60547174) |
111N00000X Chiropractor (Licence: AZ 8540) | |
Enumeration Date | 2015-04-10 |
Last Update Date | 2021-10-23 |