| NPI | 1447843206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 1022534) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: WA RN61145970) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: TX 829724) | |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2021-02-12 |