| NPI | 1598829772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024124961) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DC RN 65724) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2011-02-08 |