NPI | 1982690749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X005378-1) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1251) |
111N00000X Chiropractor (Licence: VT 006-0000794) | |
Enumeration Date | 2005-09-26 |
Last Update Date | 2007-07-08 |