| NPI | 1285079533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5089) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0013248) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2019-09-22 |