| NPI | 1336901990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DE LG-0012668) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0048025) |
| 363L00000X Nurse Practitioner (Licence: DE LG-0012668) | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-08-23 |