| NPI | 1023898616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: OK 215424) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: OK 215424) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-12-18 |