| NPI | 1235188616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH0003053) |
| Additional Taxonomies | 132700000X Dietary Manager (Licence: ID 208) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |