| NPI | 1417548660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 001012185) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-01-31 |
| Last Update Date | 2023-02-06 |