| NPI | 1942202353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7965) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG0000129) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2024-10-01 |