| NPI | 1609988286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1371) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: NY X-003440-1) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-01-08 |