NPI | 1588063754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: NC 5007064) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 18227) |
Enumeration Date | 2014-08-13 |
Last Update Date | 2021-05-10 |