| NPI | 1184769440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN7801) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 3848P) |
| 163W00000X Registered Nurse (Licence: TN RN120981) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2016-07-01 |