| NPI | 1457725723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 6919-R) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2024-07-22 |