| NPI | 1669548574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R077177) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0000518) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2010-05-05 |