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 |