| NPI | 1194912816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY 3630) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: NY 3630) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2007-09-26 |