| NPI | 1619374865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009430) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2024-11-17 |