| NPI | 1609991264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NM 424) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: NM 424) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2008-02-02 |