| NPI | 1164799383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1625) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: LA 1625) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |