NPI | 1184314536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 53-84328-051) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO C-APN.0100774-C-NP) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2025010138) | |
Enumeration Date | 2023-05-09 |
Last Update Date | 2025-06-24 |