| NPI | 1437660198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R45265) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: ND R45265) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2023-12-27 |