| NPI | 1821468893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PAT9118141) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2023-12-07 |