| NPI | 1629180377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000331) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC002769L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-21 |