| NPI | 1760037162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0013039) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0013039) |
| 163W00000X Registered Nurse (Licence: DE L1-005-132) | |
| Enumeration Date | 2019-08-03 |
| Last Update Date | 2025-10-06 |