| NPI | 1073610010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: IN 08001622) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MI 2301007361) |
| 111NN1001X Chiropractor, Nutrition (Licence: WI 3042) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MN 3164) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |