| NPI | 1548678055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: LA AP07963) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: LA APO7963) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2019-10-22 |