| NPI | 1811475213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ARNP9416109) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9416109) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP9416109) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-11-26 |