| NPI | 1114070679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3631) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000491) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2018-03-06 |