| NPI | 1225376437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO APN.1000106-NP) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP012718) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2025-05-28 |