| NPI | 1609914076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP3833) |
| Additional Taxonomies | 364SP0200X Clinical Nurse Specialist, Pediatrics (Licence: TX 561332) |
| 364SP0200X Clinical Nurse Specialist, Pediatrics (Licence: AZ RN052285) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2012-03-23 |