| NPI | 1588741482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: NY X010168-1) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NY X010168-1) |
| 111NN1001X Chiropractor, Nutrition (Licence: NJ 38MC00632700) | |
| 111NN1001X Chiropractor, Nutrition (Licence: CT 001952) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-11-04 |