| NPI | 1992770556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0012103) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN296984L) |
| 363L00000X Nurse Practitioner (Licence: PA VP003845B) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2023-01-16 |