NPI | 1982696001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NC 3737) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2947) |
Enumeration Date | 2005-08-16 |
Last Update Date | 2010-11-17 |