| NPI | 1629132766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 167) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: CT 000167) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2010-12-20 |