| NPI | 1417352568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05335) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NC 0010-05335) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2020-12-08 |