| NPI | 1891018313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA20865) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25962) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2018-12-26 |