NPI | 1437551348 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2270171) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NH 064063-21) |
Enumeration Date | 2014-09-23 |
Last Update Date | 2022-10-25 |