| NPI | 1760653166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: PR 390) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PR 390) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |