NPI | 1558526210 |
---|---|
Other Name | BERT VINCENT LAKE |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 156F00000X Technician/Technologist |
Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5852) |
Enumeration Date | 2008-07-22 |
Last Update Date | 2018-04-16 |