| NPI | 1134225931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 005903) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1768) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-02-17 |