| NPI | 1164534129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15377) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC17017) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-01-27 |