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 |