| NPI | 1598200180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60997794) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR 201810561NP-PP) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2022-06-30 |