| NPI | 1093280026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO APN.0994233-NP) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CO 994233) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2023-03-15 |