| NPI | 1184034654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95000965965) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 824952) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2016-10-05 |