| NPI | 1760400840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07215) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010807) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 011839) | |
| 111N00000X Chiropractor (Licence: TX 9071) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2013-01-28 |