| NPI | 1487860912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MN N204) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4893) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-01-30 |