| NPI | 1609014018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: FL 11452) |
| Additional Taxonomies | 111NR0400X (Licence: PR 453) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2015-06-04 |