| NPI | 1831742691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: FL APRN11003005) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CA NP95037686) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2026-01-03 |