| NPI | 1437679057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LP-0010821) |
| Additional Taxonomies | 251J00000X Nursing Care (Licence: DE L1-0050632) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010821) | |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2025-04-21 |