| NPI | 1619988524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE DEF10000398) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: DE CQ-0000037) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2023-09-20 |