| NPI | 1275506842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2957) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1975) |
| 363A00000X Physician Assistant (Licence: AL PA. 1059) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2016-11-05 |