| NPI | 1033872379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NY 350544) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: NJ 26NJ01341800) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2024-09-04 |