| NPI | 1598179640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 5806) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: CT 107198) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2014-08-06 |