| NPI | 1669190377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE LP-0010869) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024184832) |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2026-02-16 |