| NPI | 1124354139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006530) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011706-1) |
| 111N00000X Chiropractor (Licence: IL 038011785) | |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2020-11-30 |