| NPI | 1982185443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9212) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: GA 80827) |
| 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: CO PA0006179) | |
| 363A00000X Physician Assistant (Licence: WI 8683) | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2025-10-22 |