| NPI | 1942729819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG0001053) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: DE LG0001053) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2020-08-19 |