| 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 |