| NPI | 1144982034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 248604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 32521) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2023-11-08 |