| NPI | 1104929702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 760) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: CT 451) |
| 133V00000X Dietitian, Registered (Licence: CT 451) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2013-04-16 |