| NPI | 1932756905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 7665) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2020-12-17 |