| NPI | 1275755472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22114) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30450) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-08-04 |