| NPI | 1568894707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 8733335-1206) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: UT 8733335-4901) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2020-04-21 |