| NPI | 1073257986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: UT 8053541-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8053541-3102) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-10-25 |