| NPI | 1730587742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: PA SP027607) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 3413) |
| 363LP0222X Nurse Practitioner Pediatrics, Critical Care (Licence: PA SP027607) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2023-05-23 |