| NPI | 1083956536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: OR 3212) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OR 3212) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2014-08-11 |