| NPI | 1588894711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 2414) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: AZ 4754) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2019-11-04 |