| NPI | 1619183001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NM CNP01422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 17857) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: AK 469) | |
| 163W00000X Registered Nurse (Licence: NM R63290) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-11-29 |