| NPI | 1730654278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA sp019392) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG0012151) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2025-02-13 |