| NPI | 1225340078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: IL 209.0088180) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: IA C-108588) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2010-07-09 |