| NPI | 1003148495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3567) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0000772) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2024-08-23 |