| NPI | 1376956789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NV APRN002155) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 18745) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-11-03 |