| NPI | 1164487146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AR PA252) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4995) |
| 363AM0700X Physician Assistant Medical (Licence: AZ 2904) | |
| 363AS0400X Physician Assistant Surgical (Licence: AR PA252) | |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 2904) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2015-06-25 |