| NPI | 1548651284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA DN005472) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2025-12-23 |