NPI | 1326564410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008496) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0110008496) |
Enumeration Date | 2017-08-21 |
Last Update Date | 2023-02-17 |