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 |