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 |