NPI | 1619920915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 01-05027) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5623) |
Enumeration Date | 2006-05-18 |
Last Update Date | 2011-02-16 |