NPI | 1619194248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 21269) |
Additional Taxonomies | 111NR0400X (Licence: CA 21269) |
Enumeration Date | 2007-04-18 |
Last Update Date | 2008-07-21 |