| NPI | 1871129783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ PA8488) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AZ PA8488) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 100355) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-11-26 |