| NPI | 1700064136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: SC 630) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 1011) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2012-10-24 |