| NPI | 1558028555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024926) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0012397) |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2025-10-24 |