| NPI | 1821496324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP9398367) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: OH COA-16296-NP) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2015-09-15 |