| NPI | 1275671802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LP-0000155) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: PA SP016143) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2019-09-05 |