| NPI | 1497927958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP009784) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ-0000262) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2014-12-17 |