| NPI | 1255543500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: CA DC 14535) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: MA 657) |
| 111NS0005X Chiropractor Sports Physician (Licence: CA DC 14535) | |
| 111NS0005X Chiropractor Sports Physician (Licence: MA 657) | |
| 171100000X Acupuncturist (Licence: CA AC 4378) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2010-08-15 |