| NPI | 1063871176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: UT 12687356-4405) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: NM CNP-02840) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2024-06-12 |