| NPI | 1114030400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor Internist (Licence: FL 4801) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: FL 4801) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-01-21 |