| NPI | 1982666145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: FL APRN11021392) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: GA RN139407) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: GA 139407) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: TX 752986) | |
| 363LP0222X Nurse Practitioner Pediatrics, Critical Care (Licence: TX 752986) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2023-04-05 |