| NPI | 1942567235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY 2887) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MA 1329) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2016-04-08 |