| NPI | 1225989494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2026006835) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2026006835) |
| Enumeration Date | 2026-02-04 |
| Last Update Date | 2026-03-09 |