| NPI | 1043207459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22126) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-24909) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-04-07 |