| NPI | 1952463564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23282) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-09-26 |