| NPI | 1316633878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0011106) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE 111N00000X) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2026-07-08 |