| NPI | 1205964939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 19505) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 2322) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 19505) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2025-12-01 |