| NPI | 1770733255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA150160) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR PA150160) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2025-11-25 |