| NPI | 1851801195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA PA64227) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA64227) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 021540) | |
| Enumeration Date | 2017-09-30 |
| Last Update Date | 2024-06-26 |