| NPI | 1740366160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X-002011) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 003791-1) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2008-01-09 |