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 |