| 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 |