NPI | 1932178142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557290) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9612) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2018-10-31 |