| NPI | 1386144574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07928) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 1891867115) | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2023-01-03 |