| NPI | 1407190309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000616) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R159470) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |