| NPI | 1437634060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL 1-127358) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-127358) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-127358) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2023-03-01 |