| NPI | 1134355175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009012055) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2021-10-14 |