| NPI | 1770688277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0110004052) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1749) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-09-21 |