| NPI | 1669703740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175F00000X Naturopath (Licence: AZ 23-1794) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4765) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002429) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2023-08-22 |