NPI | 1790855740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010385) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27547) |
111N00000X Chiropractor (Licence: AZ 7549) | |
Enumeration Date | 2006-11-08 |
Last Update Date | 2008-04-03 |