NPI | 1679624977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3306) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 859) |
Enumeration Date | 2007-01-15 |
Last Update Date | 2008-06-24 |