NPI | 1417197971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV PA1629) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-794) |
Enumeration Date | 2009-02-24 |
Last Update Date | 2022-04-13 |