| NPI | 1659443901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0055941) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R020706) |
| 1041C0700X Social Worker, Clinical (Licence: NY R0207061) | |
| 133N00000X Nutritionist (Licence: NY 0037641) | |
| 133V00000X Dietitian, Registered (Licence: NY 0037641) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-10-25 |