| NPI | 1194702688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP010282) |
| Additional Taxonomies | 364SP0200X Clinical Nurse Specialist, Pediatrics (Licence: NJ 26NC05789400) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-04-06 |