| NPI | 1144762519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LP-0010686) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0037814) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2025-01-08 |