| NPI | 1528486289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL 1-114845) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 902668) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 9331690) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-10-19 |