NPI | 1902094378 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN174289NP) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VT 101-0028270) |
Enumeration Date | 2007-10-10 |
Last Update Date | 2010-10-27 |