| NPI | 1861768665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN016598) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 16598) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2022-09-23 |