| NPI | 1235334921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY 70 011289) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY 70 011289) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2010-04-19 |