NPI | 1073792107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP104642) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 252210) |
363LN0000X Nurse Practitioner, Neonatal (Licence: TX 252210) | |
Enumeration Date | 2007-10-25 |
Last Update Date | 2016-05-03 |