| NPI | 1629319165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CO APN-0992368-NP) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: PA SP012535) |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2018-03-17 |