| NPI | 1013999812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 3769) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: NY 1512) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2009-04-02 |