| NPI | 1407300510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5009446) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2016015539) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 135521) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: RI APRN01884) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2299983) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2024-06-19 |