| NPI | 1083121859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5831) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OR 5831) |
| 133N00000X Nutritionist | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2021-04-28 |