| NPI | 1013124908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA14039) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: CA 12087) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2009-05-16 |