| NPI | 1437349743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X2142) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NY 003527-1) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-02-22 |