| NPI | 1679653521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP007670) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP007670) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP007670) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5003907) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WV 62436) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-05-19 |