| NPI | 1588971188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO 10280) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO 180127) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2012-11-07 |