NPI | 1679802227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 30512) |
Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 12468) |
Enumeration Date | 2009-12-10 |
Last Update Date | 2012-02-06 |