NPI | 1659539369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6982285-1202) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7840) |
Enumeration Date | 2008-05-29 |
Last Update Date | 2008-05-29 |