| NPI | 1578558797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0035181) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 0037221) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2007-07-08 |