| NPI | 1245958453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA PA61663) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2023-05-01 |