NPI | 1831228147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LJ0000311) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP008398) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 002543) | |
Enumeration Date | 2007-03-04 |
Last Update Date | 2017-02-22 |