NPI | 1134442312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO 0000132) |
Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: NY 567083) |
163WD0400X Registered Nurse, Diabetes Educator (Licence: NC 252907) | |
Enumeration Date | 2010-03-02 |
Last Update Date | 2014-04-18 |