| 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 |