| NPI | 1346525201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: UT 8038048-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8038048-3102) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: UT 8038048-3102) | |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2024-03-04 |