| NPI | 1023527652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 54890) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2024-03-11 |