| NPI | 1477895621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61522) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 1057294) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2024-01-01 |