| NPI | 1134635485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MN N257) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6450) |
| Enumeration Date | 2017-12-22 |
| Last Update Date | 2024-10-15 |