| NPI | 1033889605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TN 41031) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: FL 11015381) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2026-03-24 |