| NPI | 1164749784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9350288) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1036235) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9350288) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2024-06-28 |