| NPI | 1154415297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NM 1724) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9939) |
| 111NN1001X Chiropractor, Nutrition (Licence: TX 9939) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-12-17 |