| NPI | 1164248696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175F00000X Naturopath (Licence: ID 5061875) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 171400000X (Licence: W58625) | |
| Enumeration Date | 2024-11-30 |
| Last Update Date | 2024-11-30 |