| NPI | 1730416173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NH 063595-23) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MA 262899) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2017-03-07 |