| NPI | 1487202784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09382) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 0010-09382) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2025-09-29 |