| NPI | 1336146133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9105995) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 12135) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-06-05 |