| 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 |