| NPI | 1013615673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 1111271) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1111271) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-05-23 |