| NPI | 1083193569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010825) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0012295) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2024-08-23 |