| NPI | 1689492621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: DE LP-0010825) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP030338) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-12-19 |