| NPI | 1770801060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE L10028008) |
| Additional Taxonomies | 364SP0200X Clinical Nurse Specialist, Pediatrics (Licence: DE LW-0000123) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2011-09-16 |