| NPI | 1528557311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95014358) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP141664) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60867040) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-06-01 |