| NPI | 1649378464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2187) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 0000002010) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-10-13 |