| NPI | 1033449442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9254605) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9254605) |
| 2279P3900X Respiratory Therapist, Registered, Neonatal/Pediatrics (Licence: FL RT6884) | |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: FL ARNP9254605) | |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2019-08-26 |