| NPI | 1275350225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP030788) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: PA RN729937) |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-30 |