| NPI | 1437571312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5006699) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5006699) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2020-04-16 |