| NPI | 1578792529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 9134) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: FL 9134) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |