| NPI | 1679199863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-998) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-06-27 |