| NPI | 1356660872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7856550-1202) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA DC 31638) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2015-12-11 |