| 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 |