| NPI | 1598543142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0012483) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0052530) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2023-10-31 |