NPI | 1891844619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 5126) | |
Enumeration Date | 2007-01-10 |
Last Update Date | 2020-09-15 |