NPI | 1639189731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008492) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3751) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2020-05-08 |