NPI | 1649375130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: CO 2228) |
Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MI 4625) |
111NR0200X Chiropractor, Radiology (Licence: IL 038.003452) | |
Enumeration Date | 2006-09-13 |
Last Update Date | 2009-11-30 |