| NPI | 1417348905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner Pediatrics, Critical Care (Licence: AL 1-135633) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-136533) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: AL 1-136533) | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2017-12-11 |