| NPI | 1114967247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA DC1303) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: TX 10384) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2007-07-08 |