| NPI | 1932661584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117573) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-08-25 |