| NPI | 1306991112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: CO 5888) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 535) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-05-04 |