| NPI | 1780402586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP031188) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ-0010482) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2025-11-25 |