| NPI | 1437817624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE LG-0011734) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0011734) |
| Enumeration Date | 2021-12-04 |
| Last Update Date | 2023-11-28 |