| NPI | 1083194112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: OR 20215306NP-PP) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: WI 8597) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2024-10-28 |