| NPI | 1518289982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60182518) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MT 44663) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: ID NP-946A) | |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2021-05-20 |