| NPI | 1346540929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP8909) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: AZ RN162611) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2017-03-30 |