NPI | 1972785921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: OR 3773) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3773) |
111NS0005X Chiropractor, Sports Physician (Licence: OR 3773) | |
Enumeration Date | 2007-12-01 |
Last Update Date | 2022-06-14 |