| NPI | 1851055651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95018301) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA 95018301) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2024-03-13 |