| NPI | 1609140557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP10989) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN170369) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2019-04-24 |