| NPI | 1538620844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C155676) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IA 102334) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-09-05 |