NPI | 1619428166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OK 4351) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 114814) |
Enumeration Date | 2016-10-19 |
Last Update Date | 2022-08-22 |