NPI | 1598957649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7814004-1202) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 003607) |
Enumeration Date | 2007-08-13 |
Last Update Date | 2012-09-13 |