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 |