| NPI | 1063865996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0000949) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000949) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2017-03-17 |