| NPI | 1639214208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7633) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: GA 005759) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2015-11-17 |