| NPI | 1508157405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4146) |
| Additional Taxonomies | 174400000X Specialist (Licence: DE MT-0001043) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2016-05-09 |