| NPI | 1043694276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 6556) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 6556) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: MN 154342) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2025-10-13 |