| NPI | 1700289626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR 2046) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: OR 2046) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2021-01-04 |