NPI | 1558548677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5731) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2296) |
111N00000X Chiropractor (Licence: WI 4367-12) | |
Enumeration Date | 2008-01-31 |
Last Update Date | 2020-07-13 |