| NPI | 1912556465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 903543) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 903543) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MS 903543) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2384935) | |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2024-01-12 |