| NPI | 1851965982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 000206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 206PA) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-09-07 |