| NPI | 1225306111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60388) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2022-01-12 |