| NPI | 1437282647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: CO CHR-6494) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7612) |
| 111NN1001X Chiropractor, Nutrition (Licence: AZ 7612) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2011-01-20 |