NPI | 1710608815 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11176) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 11176) |
Enumeration Date | 2022-09-07 |
Last Update Date | 2022-09-07 |