NPI | 1861511560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 113855) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA 230954) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: VT 101.0058221) | |
Enumeration Date | 2007-03-27 |
Last Update Date | 2015-01-21 |