| NPI | 1699325704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: AZ 7631) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 7631) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-12-15 |