| NPI | 1821682303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1718) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL PA.1718) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2023-06-28 |