NPI | 1972597623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6094) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007155) |
Enumeration Date | 2005-09-08 |
Last Update Date | 2009-01-05 |