| 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 |