| NPI | 1396372884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC PA200001731) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 86133258) |
| 363A00000X Physician Assistant (Licence: DC PA200001731) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-09-04 |