| NPI | 1043694276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 6556) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN 154342) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2023-09-13 |