| NPI | 1760176036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10848) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 10848) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AZ 10848) | |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2025-11-13 |