| NPI | 1083648927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10699) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5970) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-12-03 |