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 |