| NPI | 1093200107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP138325) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: TX 813526) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2021-01-08 |