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 |