| NPI | 1255026993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA pending) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: GA RN289856) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-10 |