NPI | 1588785224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03568) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555948) |
Enumeration Date | 2007-04-02 |
Last Update Date | 2017-03-02 |