NPI | 1649813502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10089080) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP027876) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 11004166) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F383080) | |
Enumeration Date | 2019-10-23 |
Last Update Date | 2024-06-13 |