| NPI | 1851721393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: IA C091812) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: IL 041.415673) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2019-09-27 |