| NPI | 1588748487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: CA 15691) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA 15691) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-12-05 |