| NPI | 1770790305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X2331) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 003798) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |