NPI | 1750469110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY f381062-1) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY f333647-1) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2015-10-28 |