| NPI | 1538565726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA LG-0000904) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2025-03-17 |