| NPI | 1740764984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000975) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011382) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2024-12-27 |