NPI | 1609974856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6634) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 0108948) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2016-05-02 |