| NPI | 1528206661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: WY 685) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: WY 685) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2014-02-05 |