NPI | 1760783963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 21279) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI PA21279) |
363AM0700X Physician Assistant, Medical (Licence: CA 21279) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 21279) | |
Enumeration Date | 2010-11-04 |
Last Update Date | 2024-03-06 |