| NPI | 1740443746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 18189) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA RN572397) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-11-01 |