| NPI | 1497215248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08856) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 0010-08856) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 0010-08856) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: NC 0010-08856) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2020-10-26 |