| NPI | 1528587003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 34965) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011300) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2020-12-16 |