| NPI | 1790107357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0090-01776) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist Psychiatric/Mental Health, Adult (Licence: NC 0090001776) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2025-02-19 |