NPI | 1598967507 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 21272) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC 29413) |
Enumeration Date | 2007-06-01 |
Last Update Date | 2019-09-11 |