| NPI | 1316591647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-00001294) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD AC003632) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2022-07-14 |