NPI | 1649352139 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-855) |
Additional Taxonomies | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: ID PA-855) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2023-11-27 |