NPI | 1174810204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F382212-1) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 382212) |
Enumeration Date | 2011-07-10 |
Last Update Date | 2015-07-16 |