| NPI | 1255734760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9290) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: AZ 14-1448) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2025-06-18 |