| NPI | 1932401064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3377) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3058) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2024-02-26 |