| NPI | 1811994585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: AZ 5280) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA DC24772) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |