| NPI | 1528844511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA 1214371) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA DN006385) |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-03-13 |