| NPI | 1801986740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 3003) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3744) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-11-22 |