| NPI | 1700294899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C010308) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2024-11-21 |