| NPI | 1639664964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: CO 0007622) |
| Additional Taxonomies | 111NR0400X (Licence: CO 0007622) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2018-06-28 |