| NPI | 1043240484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3330) |
| 363AM0700X Physician Assistant, Medical (Licence: OK 733) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-01-24 |