| NPI | 1225451727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04758) |
| Additional Taxonomies | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: NC 001004758) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2024-09-11 |