NPI | 1578021473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11014592) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 2289024) |
Enumeration Date | 2019-03-10 |
Last Update Date | 2021-10-19 |