| NPI | 1023522331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX AP135871) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX AP135871) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2022-02-01 |