| NPI | 1477858553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03752) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000996) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MD S03752) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: MD S03752) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: DE F1-0000996) | |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2021-01-19 |