| NPI | 1821267782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ-0000241) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: DE L1-0030111) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: PA RN530634L) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP009665) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2012-01-20 |