| NPI | 1144862863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: MS DANC-D5HFKH) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: MS DANC-D5HFKH) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |