NPI | 1790187565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-03401) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0185546) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: NM CNP-03401) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: CO APN.0991376-NP) | |
Enumeration Date | 2014-09-23 |
Last Update Date | 2024-03-01 |