| NPI | 1083276356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 006537) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 86092204) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2024-04-23 |