| NPI | 1881773109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006509) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 003726) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2016-02-16 |