NPI | 1861601528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5091) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5856) |
111N00000X Chiropractor (Licence: CA 29940) | |
111N00000X Chiropractor (Licence: IL 038011001) | |
Enumeration Date | 2007-05-21 |
Last Update Date | 2009-05-21 |