| NPI | 1760480925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3028) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 807851) |
| 247200000X Technician, Other | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-10-02 |