| NPI | 1134668379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 22306) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MD AC002679) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2022-10-05 |