| NPI | 1164434478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 656) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: LA 656) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2010-11-02 |