| NPI | 1396846242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP9460277) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WV 48666) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-07-21 |