| NPI | 1063744027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 70011788) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NY 70011788) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2016-08-15 |