| NPI | 1942829643 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LM-0000177) | 
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: DE LM-0000177) | 
| Enumeration Date | 2020-04-13 | 
| Last Update Date | 2025-09-24 |