| NPI | 1821028861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: UT 5578639-1202) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NV B01172) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-02-17 |