| 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 |