| NPI | 1881992139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704250694) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MI 4704250694) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 800720) | |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-06-23 |