| NPI | 1538261425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 23146) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29082) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2014-03-05 |