| NPI | 1699833749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000477) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: DE F1-0000477) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2025-07-01 |