| NPI | 1427111715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9100777) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-02-23 |