| NPI | 1437143781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001641) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IA 1641) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2020-07-27 |