| NPI | 1063766723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO chr6922) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2015-01-29 |