| NPI | 1730530619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: MI 4704180803) |
| Additional Taxonomies | 101Y00000X Counselor |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2016-06-22 |