NPI | 1801167051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: HI 1684) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA NP21018) |
Enumeration Date | 2012-01-19 |
Last Update Date | 2016-01-27 |