| NPI | 1083585889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA A186983) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A186983) |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-12-10 |