| NPI | 1568765485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NH 083906-23) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN266873) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: RI APRN00140) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2021-02-03 |