| NPI | 1881790905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000978) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010220) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2025-07-09 |