NPI | 1275909301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209014555) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041443589) |
Enumeration Date | 2015-08-12 |
Last Update Date | 2019-07-24 |