| NPI | 1073711560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: WA NU00001694) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC00002522) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2007-07-08 |