| NPI | 1932328762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY 9708-1) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY 9708-1) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |