| NPI | 1235454497 |
|---|---|
| Former Name | BRANDON TYLER GARLAND |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CO CDRH.0055618) |
| Additional Taxonomies | 2086S0129X (Licence: WA MD60402101) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2025-10-14 |