| 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 |