| NPI | 1639688252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 8030-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8030-33) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2022-07-21 |