| 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 |