NPI | 1154690618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X005814) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 960913) |
Enumeration Date | 2011-12-29 |
Last Update Date | 2011-12-29 |