| NPI | 1841760576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08871) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 0010-08871) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 0010-08871) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 0010-08871) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 0010-08871) | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2019-03-28 |