| NPI | 1861692105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6837627-1206) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034774) |
| 111N00000X Chiropractor (Licence: UT 68376271202) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2022-07-21 |