| NPI | 1730786104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: FL APRN11012765) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MD R196579) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2022-11-02 |