| NPI | 1649776261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: VA 0024175964) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024175964) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-01-15 |