| 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 |