| NPI | 1700042975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000763) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556640) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2019-04-17 |