| NPI | 1770264475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 12164) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 183661) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-09-17 |