| NPI | 1295863694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 5202223-1206) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 5202223-1202) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2021-09-09 |