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 | 2024-11-11 |