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 |