| NPI | 1801355847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9112113) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 9112113) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-10-02 |