| NPI | 1700509296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0012102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0036577) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2023-06-06 |