| NPI | 1568752830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 02349) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |