NPI | 1649328170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 358787-1202) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 3948) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2007-08-20 |