| NPI | 1548786858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0003202-NP) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CO APN.0003202) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO 0003202) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2021-06-29 |