| NPI | 1730648429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 30078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 201475) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2022-03-28 |