| NPI | 1235782400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11001995) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: FL APRN11001995) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2024-04-30 |