| NPI | 1982783460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: OR 201602863NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD AC000238) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2024-09-12 |