| NPI | 1467607622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704284732) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 13792) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71003208A) | |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2011-12-28 |