| NPI | 1346919479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: MT 102260) |
| Enumeration Date | 2021-09-11 |
| Last Update Date | 2023-07-13 |