| NPI | 1396268058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL ND6497) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |