| NPI | 1093085276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 8185027-1206) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8185027-1202) |
| 363A00000X Physician Assistant (Licence: UT 8185027-1206) | |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2023-03-29 |