| NPI | 1316699820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8993) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AZ 8993) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2023-12-01 |