| NPI | 1184889610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 240448) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC RN1013160) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: DC RN1013160) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2019-11-19 |