| NPI | 1740768365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 7924) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2291141) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2022-09-22 |