NPI | 1578689071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04087) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-30443) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2022-01-04 |