| NPI | 1285173708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: FL APRN9473831) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F341409) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2019-05-16 |