| NPI | 1205948981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 9700154) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 18527) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP 9219935) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-12-06 |