| NPI | 1548408107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 67341) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3591) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2026-06-23 |