| NPI | 1134222755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03104) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071006839) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2016-04-27 |