| NPI | 1033735295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C174109) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA C174109) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IA C174109) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-07-13 |