| NPI | 1487732681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006053-1) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 004029-1) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |