| NPI | 1083069462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011128) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-12-13 |