| NPI | 1457883068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 1178331) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 86006556) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2020-11-10 |