NPI | 1881816874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NR0400X (Licence: TX 09511) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 9511) |
Enumeration Date | 2007-05-02 |
Last Update Date | 2023-01-10 |