| NPI | 1154413995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LJ0000211) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ0000211) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-09-24 |