| NPI | 1447728217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0001270) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0001270) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE C5-0001270) | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2024-01-04 |