NPI | 1649271610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 799) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3957) |
Enumeration Date | 2005-08-02 |
Last Update Date | 2019-07-16 |