| NPI | 1831767367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DE LG-0011663) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP023899) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-08-05 |