NPI | 1558028704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05166) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010659) |
Enumeration Date | 2021-11-23 |
Last Update Date | 2022-04-28 |