| NPI | 1003863911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 844835) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA 26NR15716600) |
| 163W00000X Registered Nurse (Licence: PA RN513438L) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA TP006788D) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NJ 26NJ00355300) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2019-03-07 |