| NPI | 1811137649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: CT 001341) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: CT 001341) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-07-16 |