| 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 |