| NPI | 1184336844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AR 124455) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R088793) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2023-02-08 |