| NPI | 1982938262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA 2276332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 084801) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 4191) | |
| Enumeration Date | 2009-09-19 |
| Last Update Date | 2021-02-01 |