| NPI | 1215079819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY X005168) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 003768) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-09 |