| NPI | 1184020554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP014445) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP014445) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP014445) | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2014-11-14 |