| 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 |