| NPI | 1598159568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE lg-0001303) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN664437) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2019-10-28 |