NPI | 1720149230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00574) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3104) |
111N00000X Chiropractor (Licence: CA DC30042) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2008-10-14 |