| NPI | 1316166358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 003-776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x3468) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2025-09-11 |