| NPI | 1609900810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA NP11899) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP11899) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2012-01-31 |