| NPI | 1255882437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0008084) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: MD J0000066) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2021-08-16 |