| NPI | 1245216084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX 05867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9687) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2011-12-07 |