| NPI | 1962536003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN11543) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: TN 11543) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-07-27 |