| NPI | 1326445081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NV APRN002528) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN651182) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP014515) | |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2019-09-24 |