NPI | 1972576205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6033) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06535) |
111N00000X Chiropractor (Licence: UT 6252605-1201) | |
Enumeration Date | 2006-02-08 |
Last Update Date | 2017-04-25 |