| NPI | 1982182184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 9401713) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9401713) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2024-10-24 |