| NPI | 1588494397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3007165) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007165) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-11-13 |