| NPI | 1932291473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65796) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29908) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2025-02-04 |