| NPI | 1427646116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA PA60737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA19277) |
| 207Y00000X Otolaryngology (Licence: CA 60737) | |
| 363A00000X Physician Assistant (Licence: CA PA60737) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2026-07-01 |