| NPI | 1316094758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA21688) |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2022-07-21 |