| NPI | 1104449024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114672) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL PA9114672) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2023-10-19 |