| 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 |