| NPI | 1033534169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: WI 6493) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 6493) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: IL 209011077) | |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2019-02-01 |