| 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 |