NPI | 1669586210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000295) |
Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: VA 0104000295) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2012-01-19 |