NPI | 1902274194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2015029733) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05735) |
Enumeration Date | 2015-09-04 |
Last Update Date | 2015-09-04 |