NPI | 1487620621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 9450322) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 488071) |
Enumeration Date | 2006-02-27 |
Last Update Date | 2020-02-18 |