| NPI | 1134301716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 19423) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA DC19567) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2022-12-09 |