| NPI | 1467584532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA PA 18316) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18316) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2009-12-07 |