| NPI | 1851306419 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000905) | 
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DG26782) | 
| Enumeration Date | 2006-07-30 | 
| Last Update Date | 2024-02-08 |