| NPI | 1497412399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0011831) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188207) |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2024-05-14 |