| NPI | 1205168267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0000528) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: DE L1-0037161) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2016-04-08 |