| NPI | 1316218050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3771) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21788) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2013-10-01 |