| NPI | 1780740985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: NM R33523) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-00693) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2021-04-07 |