| NPI | 1841257508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 102512) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 102512) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2021-09-01 |