NPI | 1619619228 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: SC 25984) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SC 25984) |
Enumeration Date | 2022-04-13 |
Last Update Date | 2022-08-15 |