| NPI | 1427060375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104091) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH5345) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9104091) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-10-21 |