NPI | 1588337729 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MO 2021025121) |
Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: KS 53-80323-042) |
Enumeration Date | 2021-07-25 |
Last Update Date | 2021-07-25 |