| NPI | 1891968657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY 011486) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NJ 38MC00683100) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2018-03-17 |