| NPI | 1396876348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation |
| 111NS0005X Chiropractor Sports Physician | |
| 111NX0800X Chiropractor Orthopedic | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-07-08 |