NPI | 1780048082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557343) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011147) |
Enumeration Date | 2016-04-12 |
Last Update Date | 2022-05-20 |