| NPI | 1588187546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F382837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 717958) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2021-07-12 |