| NPI | 1700831476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7082) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2246) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-12-28 |