| NPI | 1528100351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC04281) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X3225) |
| 133N00000X Nutritionist (Licence: NY 3945-1) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2015-11-12 |